Patient Forms

Clinic Policies

Cancellation policy:

  • If you are unable to attend an appointment, please let us know as soon as possible so that we can assign your time slot to someone else. We ask for at least 1 business day cancellation notice for all appointments. IFHA business days are Monday, Tuesday, Thursday, and Friday; we are closed on Wednesday.
  • We reserve the right to charge the following fees for missed appointments or last-minute cancellations:
    • $50 for 30 minute appointments
    • $100 for 60 minute appointments
    • $150 for 90 minute appointments
  • We reserve the right to charge a $150 fee for repeated missed or repeated last-minute cancellations.
  • Please be aware that during the clinic’s premium hours of Thursdays 5pm-8pm and Saturdays 8am-12pm, the maximum fee of $150 will be assessed regardless of how much time was scheduled for the missed appointment. Out of respect for the time of all patients and IFHA staff, we appreciate your cooperation with attending your scheduled appointments.
  • If you are more than 20 minutes late to your scheduled appointment, we will make every effort to work you back into the physician’s or nurse practitioner’s schedule. However, as a courtesy to our patients scheduled after you, we may have no choice but to reschedule your appointment.

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New Patient Registration Guide

How to register as a new patient
  1. If you have not already scheduled an appointment with us, please call our office at (708) 482-1099 to do so. You will need to provide the following basic information to the front desk person:
    • Name
    • Date of birth
    • Insurance information (if applicable)
    • Phone number
    • Email address (this will allow you to communicate with our office electronically).
  2. Please print out the following form and bring in a completed copy to your visit. Completing this paperwork in advance will save you time at our clinic.
  3. Within 24 hours of scheduling your first appointment, you should receive a welcome email containing your Patient Portal Login ID and Password or we will provide you with a Login ID and Password by phone. If you do not receive your welcome email or phone call, please call us to let us know.
  4. Using your Login ID and Password, log into the Patient Portal and complete the “HIPAA”, “Clinic Policies”, and “Integrative Family Health Associates” forms, available in the Portal from the “Patient Form” link on the left side of the screen. For each form, make sure that you press “SAVE” and then “SUBMIT” after completing the information. For more information about the Patient Portal and step-by-step instructions for logging in and completing the forms, view our Patient Portal Details section below.
    ***Note: You must use Internet Explorer in order to log into the Patient Portal.
    ** Remember: you must press SAVE and then SUBMIT, in that order, to successfully save your changes.
  5. If you are not using our Patient Portal because you do not have access to a computer or have a Mac, we ask that you come in a half hour prior to your scheduled appointment time to fill out the forms in our office on our computer. Please come prepared with your health history, pertinent information, and dates.
  6. Congratulations, you have completed the New Patient Registration! Please remember to bring in your completed forms (Demographic and Insurance forms) and do not lose your Patient Portal login information. We look forward to seeing your very soon!

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Printable Forms

  • Demographic and Insurance Form – Needs to be filled out by all new patients.
  • Medical History Form – Required by all patients that have not completed the corresponding form on the Patient Portal (see below for details on the Patient Portal).
  • HIPAA Notice – Required by all patients that have not completed the corresponding form on the Patient Portal (see below for details on the Patient Portal).

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What is the Patient Portal?

The Patient Portal is a secure, interactive website that allows you to communicate with us in a HIPAA-secure manner. Using the portal, you will be able to view your medical history, medications, lab results, test results, and health reminders. You will also be able to send messages to any of the doctors or to the general staff regarding prescription refills, appointment requests, supplement orders, or other questions you might have. We can respond to your questions within the Patient Portal, at which time you will receive a notification in your regular email account. By keeping the information inside the Patient Portal, it remains private and secure.

What is required to log into the Patient Portal?

You must use Internet Explorer to log into the Patient Portal. In order to log in, you must have your User ID and Password.

How do I get a User ID and Password to the Patient Portal?

You should receive your User ID and Password within 24 hours after making your appointment. If you have not received your User ID and Password, call our clinic at (708) 482-1099 and we will help you.

What steps should I follow when logging into the Patient Portal for the first time?

  1. There are Patient Portal login areas on the right side of every page throughout this website. Using Internet Explorer, enter in your User ID and Password then press the “Login” button.
  2. If this is the first time you are logging in, you will be prompted to change your password and create a secret question/answer. After you change your password and secret question, keep that information in a secure location for future reference.
    ***Note: Your new password must be at least eight (8) characters long, but not longer than ten (10) characters, and contain at least one number and one letter.
  3. Once you are logged into the Patient Portal and have reached the main page, find and click on the “Patient Form” link (it will be on the left side of the screen, under the “Clinic Interaction” heading). This should launch the Patient Form window.
  4. At the top of the new window is a drop-down selection box where you can choose which form to use. Choose the “HIPAA” form first.
  5. After reading through the HIPAA form, click the “Yes” box at the bottom-left of the page to indicate that you agree with the form. Then click the gray box to the right of the “HIPAA Signed On date” field to choose today’s date.
  6. Press the “SAVE” button to save the form and then the “SUBMIT” button to send your form to our clinic.
  7. From the form selection drop-down box at the top of your window, change to the “Clinic Policies” form.
  8. Read the policies, click the “Yes” box, and click the gray box to the right of the “Signed on date” field to choose today’s date. Finally, press the “SAVE” button to save the form and then the “SUBMIT” button to send your form to our clinic.
  9. Next, from the form selection drop-down box at the top of your window, change to the “Integrative Family Health Associates” form.
  10. Complete as much information as you can. Once your answers are complete, press the “SAVE” button and then the “SUBMIT” button to upload your information to our clinic.
  11. You are done filling out our forms, so you should close the Patient Portal window and, for the best security, the web browser.

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